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Clinical Preventive Services
Steven Ornstein, M.D., Associate Professor, Department of Family Medicine, Director, Practice
Partner Research Network, Center for Health Care Research, Medical University of South Carolina, Charleston, SC.
Interest in the use of preventive services to decrease morbidity and mortality rates in the United States is on the rise. However, because primary care physicians lack sufficient time and resources to provide comprehensive preventive services for patients at each visit, electronically developed reminder systems can greatly improve the delivery of preventive care. As early as 1972, South Carolina Medical University began using such computer-generated physician reminders. Dr. Ornstein described how reminder systems are utilized, provided tips from "best practices," and offered suggestions for State and local government assistance efforts.
Paper-based medical records are obstacles to optimal preventive services delivery for several reasons, although they are currently used by more than 90 percent of physicians:
- Maintaining accurate preventive services records requires extensive data entry, which is time-intensive and has the potential for errors.
- Reminding physicians and patients about needed preventive services is more difficult without the help of an electronic reminder system.
- There is increasing difficulty for physicians to incorporate audits and quality improvement efforts into clinical care.
Electronic medical records (EMRs) avoid these impediments by providing the following:
- Unique, practicewide protocols.
- Physician and patient reminders.
- Linkages to guidelines and documentation tools.
- Patient education materials.
- Effective submission of encounter data to expedite data-analysis efforts.
Despite the initial drawbacks of implementing the EMR system, such as high cost and time-intensiveness, many clinics using EMRs have documented improved preventive services delivery and better disease management for their patients. By examining clinics that have successfully incorporated preventive services into practice, many implementation lessons were learned. In order to be effective, the clinics must:
- Make prevention a priority and incorporate patient and physician reminders into protocols.
- Provide patient education and outreach services.
- Conduct adequate followup with patients.
There are significant steps that must be made before EMRs can become standard clinical practice. To improve the delivery of preventive care services, State and local governments can facilitate the integration of EMRs into clinical practice by:
- Eliminating legal and financial disincentives.
- Providing incentives to adopt EMR technology.
- Providing grants for practices that collaborate with public health programs.
- Providing rewards/incentives for high performance.
- Providing preventive services incentives for government employees.
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